Medicaid Unwinding Led to Millions Losing Coverage but Modest Increases in Uninsurance, Study Finds
The end of Medicaid’s continuous coverage provision—initiated in April 2023 after 3 years of pandemic protections—resulted in more than 25 million disenrollments nationwide, according to a new cross-sectional study analyzing federal and state data. Despite the massive scale of coverage terminations, the overall uninsurance rate showed only modest changes, suggesting that many individuals were able to reenroll in Medicaid or transition to other forms of coverage.
Using administrative data from the US Centers for Medicare & Medicaid Services (CMS) and self-reported survey data from the National Health Insurance Survey between 2019 and 2023, researchers assessed state-by-state differences in disenrollment, demographic trends, and new application patterns. The study analyzed data collected through April 2024 and evaluated outcomes from November 2024 through July 2025, offering one of the most comprehensive assessments yet of the unwinding’s early effects.
During the first year of unwinding, states experienced vastly different disenrollment rates. The median state termination rate reached 26.6% of pre-unwinding Medicaid enrollment, ranging from 8.3% to 55.3%. However, when accounting for new and returning enrollees, the median net enrollment decrease was smaller at 13.9%, with some states even seeing net gains. These differences reflect the uneven pace of procedural reviews and renewal policies implemented at the state level.
Importantly, application patterns shifted sharply during and after the pandemic. New Medicaid applications fell by nearly 30% during the COVID-19 pandemic but rose by roughly the same proportion once redeterminations resumed in 2023. The study found that “gaps between administratively measured and survey-measured enrollment grew during the COVID-19 pandemic but narrowed during unwinding,” highlighting discrepancies in how coverage loss was reported and perceived.
Demographically, coverage declines were concentrated among specific groups. Survey data indicated decreases in Medicaid enrollment among women (−2.74 percentage points), healthier adults (−2.65), young adults (−3.37), recently pregnant adults (−8.19), and White individuals (−2.85). Changes in uninsurance were modest overall but rose significantly among healthier individuals, suggesting that they may have been less likely to seek re-enrollment or alternative coverage.
The study also reported an increase in cost-related barriers to care, especially among White, college-educated, and healthier individuals—populations less traditionally at risk for coverage gaps. These findings suggest that even small shifts in Medicaid participation can have broad implications for perceived affordability and access to care.
The findings underscore the complexity of Medicaid’s unwinding process and its implications for future coverage policy. While administrative terminations were extensive, self-reported uninsured rates remained relatively steady through the end of 2023. Researchers concluded that “enrollee confusion, re-enrollment in Medicaid, and transitions to alternative coverage each contributed to this apparent contradiction.”
For payers and managed care organizations, these results point to both opportunity and caution. The rapid churn in Medicaid enrollment highlights the need for proactive outreach and streamlined re-enrollment processes to reduce administrative barriers. Policymakers considering new eligibility verification or renewal procedures should note that even temporary interruptions in coverage can lead to measurable increases in care delays and affordability challenges.
Overall, the study suggests that while the unwinding of Medicaid’s continuous coverage provision marked one of the largest shifts in US insurance coverage in recent history, its true impact on uninsured rates and care access depends heavily on state policies and how effectively individuals navigate the reenrollment process.
Reference
McIntyre A, Morein M, Kim J, et al. US coverage changes during Medicaid unwinding in 2023. JAMA Health Forum. 2025;6(10):e253887. doi:10.1001/jamahealthforum.2025.3887
